Healthcare Provider Details

I. General information

NPI: 1790649564
Provider Name (Legal Business Name): MEGAN MARONN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18510 N DALE MABRY HWY
LUTZ FL
33548-7900
US

IV. Provider business mailing address

18510 N DALE MABRY HWY
LUTZ FL
33548-7900
US

V. Phone/Fax

Practice location:
  • Phone: 813-262-0460
  • Fax:
Mailing address:
  • Phone: 813-262-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: